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Michigan rates for HCPCS A6404

Gauze Non-Impregnated Sterile Pad Size More Than 48 Sq. In. Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.25 / $0.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.25 / $0.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $3.61 / $7.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.31 / $1.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.83
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.33 / $0.33
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.25 / $0.33 / $0.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.64 / $75.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.22 / $0.39